The hookworm inoculation rash

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The rash

A successful first hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] frequently causes a short-lived but often itchy, pink and possibly raised rash at the inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] site as a result of the immune system reacting to the worms’ entry into the skin. [1] [2] However, some may have a rash without itching:

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I got very little itch, just barely detectable if at all, but I got easily visible red bumps that stayed for several days. [3]

While others can experience itching but no rash, and some may have no physical signs whatsoever.

When there is a rash at the inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] site, the number of red dots does not necessarily indicate the number of larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. that have entered the skin. Since larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. tend to clump together and are microscopic, several may enter in close proximity, leaving what looks to the naked eye like a single entry point. So, with no one-to-one, worm-to-spot relationship, the number of visible entry points can only provide a rough guide to the number inoculated.

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I recently did 6 live wrigglers and dropped them off slide onto bandage ... checked slide for stragglers all good and i got 2 bumps... so unless you are individually applying its not a great way to count them. [4]

The only certainty is that, if there is a rash, then at least as many worms will have entered the skin as there are spots.

To examine the rash more closely, photograph your arm in bright light with a macro lens, then use the computer monitor to count any visible spots.

Skin response may not necessarily predict outcome

The severity of the skin response is not a reliable indication of a successful outcome from the therapy, and nor is the appearance of a bounce or the presence, absence, or severity of side effects.

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My first dose I had quite a severe reaction at the site, blisters & marks that lasted for ever (but) I have had no benefits to my allergies at all.” [5]

Future reactivation of the rash

The inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] site may suddenly flare and become itchy again weeks or months after an inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation]. This might occur when the worms start to attach to the inner wall of the intestine to feed for the first time on or after day 21, or at the peak of the immune response to a new batch of worms at around 7 weeks.

This phenomenon may be the result of the L3 larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. having shed their cuticles and sheaths during their migration through the host’s skin. [6] When the immune system detects similar material during the later stages of the worms’ migration, and when they begin to feed from the intestinal wall, it releases antibodies to those types of cells or proteins wherever they occur, including in the skin, which can flare as a result.

Two hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. self-treaters have reported a reactivation of the inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] site on or around day 12, [7], [8] and another experienced a flare of her rash at 7 weeks. [9]

Yet another self-treaterSomeone who treats their own disease or condition without medical assistance. experienced a rash in the area of an old inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] site when exposed to sun for the first time in a while. [10]

If there is no rash

An absence of any indication that the larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. have entered the skin is especially likely if the self-treaterSomeone who treats their own disease or condition without medical assistance. is taking an immunosuppressant drug such as prednisone/prednisolone. Even low-dose steroids, such as those used in inhalers, can profoundly reduce the skin reaction to inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation], although a few subjects who are taking steroids may still develop an itch and/or rash.

In a few cases, a lack of any skin response may indicate that the larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. failed to survive the rigours of the journey, perhaps as a result of them being exposed to extremes of temperature during transit, especially at altitude during flight, where everything at or near the edge of a pallet will freeze. For more information about this possibility, see Storage and survival of hookworm larvae.

The absence of a rash may not indicate a failed inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation]

Where there is no visible confirmation that inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] was successful, it might be assumed that the larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. were all dead, but they may not be.

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I had zero rash the first time... No rash the second time either but in both cases gut symptoms... So no rash does not necessarily mean no worms. [11]
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My wife has yet to see any sign of entry on either dose of hers, but has seen huge effects afterwards. Don't take a small or nonexistent reaction to mean it didn't take. [12]
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My first inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] of 10 HWhookworm, usually referring to the human hookworm, Necator americanus was 11 days ago and I had absolutely no response at all, nothing on the skin or anything of note since... That is until today when the inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] site has some small raised reddish bumps. [13]
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I did not get a rash and I did not see any side effects until week 3. [14]

In the absence of a rash, the subject may be tempted to add more worms immediately. However, it is advisable to wait rather than immediately order a replacement dose because side effects can appear suddenly, “out of nowhere”, a few weeks after an apparently unsuccessful inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation], confirming that the original dose was viable after all.

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I inoculated with 10 HWhookworm, usually referring to the human hookworm, Necator americanus at the end of September. I had zero issues and was thinking of doing a second round of ten right away. Then, in the beginning of November I suffered from a massive increase in stomach acid production, which brought on GERD and gastritis type symptoms, along with other GIGastroenterology is the branch of medicine concerned with disorders of the digestive system which includes all the organs of the gastrointestinal (GI) tract (alimentary canal) from mouth to anus. Physicians practicing in this field of medicine are called gastroenterologists or GI specialists. symptoms characteristic of HWhookworm, usually referring to the human hookworm, Necator americanus infection. It was really bad for three weeks... [15]
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Well, I finally have decided (39 days in) that my 10 are there - just a little slow on the uptake. The last couple of days the gut has become increasingly uncomfortable, with some severe pains and quite a lot of dizzy spells. Feeling quite a bit worse for wear, so I guess they were quiet arriving but are now settling in... Glad I decided not to use the replacement dose! [16]
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I actually didn't think the inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] worked, as I only had a slight tingle for a few minutes and the rash was super light and gone in 3 days with no itching. Fast forward 5 weeks and they've made it clear they're here! [17]

If these individuals had added a second dose of larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. within the first 12 weeks, they would have faced the possibility of having to run the gauntlet of greatly increased side effects which could have been so severe as to necessitate termination. It may therefore be wise, in the absence of a skin response, to wait for several weeks before reinoculating. One individual who did this after getting no rash, only very minor itching, and no other obvious symptoms in the first few days, suddenly developed the typical gastrointestinal side effects three weeks later, including bloating, nausea, diarrhoea and significant fatigue.

The absence of a rash may not predict reduced side effects

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My skin reaction was minimal, but systemic reaction all but intolerable... [18]

Determining whether inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] was successful


In the absence of an obvious skin response, there are two approaches that can help to determine whether or not inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] was successful.

1. If you had a full blood count (CBC) and/or IgE levels taken just before inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation], you could retest a couple of weeks after the inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation]. If there has been an increase in eosinophilsEosinophils are a specialised type of white blood cell with a variety of both harmful and beneficial functions. Their numbers rise temporarily following inoculation with helminths., this would suggest that infection is likely, although there are other factors that can influence eosinophilEosinophils are a specialised type of white blood cell with a variety of both harmful and beneficial functions. Their numbers rise temporarily following inoculation with helminths. levels.

2. The only definitive test is stool analysis, which can be carried out once the worms begin producting eggs between 4 and 6 weeks post inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation]. For more details, see Stool testing (egg counting).

Development of inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] rashes over time

The first few hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. doses tend to produce a successively more pronounced skin rash, with the fourth and fifth inoculations leaving some people with a very angry-looking bright red rash which can develop fluid-filled blisters/vesicles that may ooze exudateCells and fluid that seep out of blood vessels during inflammation..

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I got almost no itch with the first dose of HWhookworm, usually referring to the human hookworm, Necator americanus. As I understand it, the immune system isn't prepared for that first intrusion through the skin. But by the second dose, your little soldiers are alert and they converge quite intensely on the migration site. My 2nd, 3rd, and 4th skin reactions grew increasingly severe. [19]
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My 4th is still itching and blotchy after 3 weeks, nearly drove me crazy. [20]

Some people begin to experience less severe rashes after the fourth or fifth inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation].

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My response increased for the first few - my fourth was the worst. Oozed for 10 weeks and left a noticeable scar. Subsequent inoculations have gotten easier. My seventh quit oozing by 5 or 6 days and was completely healed in 2 weeks. [21]
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For me the 5th was by far the worst, so it was a real relief when my reaction to the 6th dose was vastly smaller. [22]

Others can continue to get very angry and itchy rashes indefinitely.

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I always get a swollen runny angry rash. It takes a couple months to disappear. [23]

And some people may eventually develop an additional area of inflammation extending for several inches around the rash. This area of cellulitis may appear bruised, can be quite swollen, and may possibly also be as itchy as the rash itself.

But some successful supplementary inoculations may fail to produce any reaction.

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My last one, #6, gave me practically no itching at the time. Definitely worked though. [24]

Others have reported their experience of the intensity of the inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] rash after each dose of NAthe human hookworm, Necator americanus in this Support group thread.

Feedback from a couple of very early HThelminthic therapy pioneers suggests that, in some people, the rash severity may reduce significantly after hosting hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. for more than 6 years.

See also

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